بررسی ضخامت اولتراسونیک عضلات دیواره طرفی شکم در بیماران با کمردرد مزمن غیراختصاصی بر اساس زیرگروه‌های پرسش‌نامه STarT

نوع مقاله: مقاله پژوهشی

نویسندگان

1 دانشیار گروه فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

2 گروه فیزیوتراپی، دانشکده توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

3 استاد آمار زیستی، گروه علوم پایه، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

4 استاد گروه فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

چکیده

مقدمهواهداف
پرسش­نامه STarT به عنوان ابزاری برای تصمیم­گیری بالینی و انتخاب نوع درمان در بیماران با کمردرد مزمن غیراختصاصی معرفی شده است. هدف پژوهش حاضر مقایسه ضخامت اولتراسونیک عضلات دیواره طرفی شکم بین زیرگروه­های کمردرد مزمن غیراختصاصی بر اساس پرسش­نامه STarT بود.
مواد و روش­ ها
17 بیمار مرد مبتلا به کمردرد مزمن غیراختصاصی که بر اساس پرسش­نامه STarT 10 نفر در گروه خفیف و 7 نفر در گروه متوسط قرار داشتند، در این مطالعه تحلیلی شرکت کردند. ضخامت اولتراسونیک عضلات دیواره طرفی شکم بیماران در حالت استراحت و انقباض در وضعیت طاق‌باز اندازه‌گیری شد. از آزمون‌های شاپیرو-ویلک، تحلیل پراکندگی با اندازه‌گیری مکرر و t زوجی برای تحلیل داده‌ها استفاده گردید. در تمامی آزمون‌ها سطح معنادار 05/0>p در نظر گرفته شد.
یافته‌ها
در بررسی ارتباط متقابل بین زیرگروه کمردردی و ضخامت اولتراسونیک عضلات دیواره طرفی شکم، تفاوت معناداری نه در ضخامت استراحت (149/0=p ,318/2F=) و نه در ضخامت انقباض (065/0p= ,965/3F=) عضلات مورد بررسی مشاهده نگردید. در بررسی ارتباط متقابل گروه و وضعیت (استراحت و انقباض)، در هر دو گروه، سه عضله مایل داخلی،عرضی شکم و مایل خارجی در وضعیت انقباض ضخامت بالاتری نسبت به استراحت داشتند (02/0=p ،001/0=p و 007/0=p). در هیچ یک از عضلات مورد بررسی تفاوت معناداری بین ضخامت در سمت چپ و راست، چه در وضعیت استراحت و چه در وضعیت انقباض مشاهده نگردید (05/0<p).
نتیجه‌ گیری
با توجه به عدم مشاهده تفاوت در ضخامت اولتراسونیک عضلات دیواره طرفی شکم بین زیرگروه‌های بیماران کمردرد مزمن غیراختصاصی بر اساس پرسش­نامه STarT، توصیه می شود استفاده از این پرسش­نامه جهت تعیین نوع درمان قبل از شروع برنامه درمانی، بر اساس یافته­های حاصل از ارزیابی­های بالینی انجام گیرد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Ultrasonic Thickness of Abdominal Wall Muscles in Non-Specific Chronic Low Back Pain Patients based on STarT Questionnaire

نویسندگان [English]

  • Farideh Dehghan Manshadi 1
  • Younes Amiri 2
  • Najmeh Sedighimehr 2
  • Alireza Akbarzadeh Baghban 3
  • Asghar Rezasoltani 4
1 Ph.D, Associate professor in Physiotherapy , Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Physiotherapy Department, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Professor, Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Ph.D, Professor in Physiotherapy , Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده [English]

Background and Aim: The Multidimensional STarT Questionnaire is an index of clinical decision making and the choice of treatment type in patients with Nonspecific Chronic Low Back Pain (NSCLBP). The aim of the present study was to compare the ultrasonic thickness of abdominal wall muscles between NSCLBP subgroups based on StarT Questionnaire.
Materials and Methods: A total of 17 male patients with NSCLBP participated in the current analytical study. Based on the STarT Questionnaire, 10 participants were placed in the mild subgroup and 7 in the moderate subgroup. The ultrasonic thickness of abdominal wall muscles was measured at rest and contraction in the supine position. Kolmogorov-Smirnov tests, spatial analysis with repeated measure, and paired t-test were used for data analysis. Values p< 0.05 were considered statistically significant.
Results: There was no significant difference in resting (F=2.318   p=0.149), and contraction (F= 3.965, p=0.065) thickness of abdominal wall muscles in two subgroups of NSCLBP patients. All three muscles (internal oblique, transversus abdominis, and external oblique) in contraction were thicker than in the rest condition (p=0.02, p=0.001, p=0.007, respectively). Moreover, there was no significant difference between the thickness of the left and right in either of the muscles, whether in the rest or in the contraction condition (p>0.05).
Conclusion: Considering no difference in ultrasonic thickness of the abdominal wall muscles between the NSCLBP subgroups based on the STarT Questionnaire, it is recommended that the findings of clinical examinations be used to determine the approach of treatment in the subgroups of NSCLBP patients.

کلیدواژه‌ها [English]

  • Chronic non-specific low back pain
  • STarT Questionnaire
  • Ultrasonography
  • lateral abdominal wall muscles
1.Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C. The global burden of low back pain: estimates of the Global Burden of Disease 2010 study. Annals of the rheumatic diseases. 2014 Jun 1; 73)6 (: 968-74.##

2.Iizuka Y, Iizuka H, Mieda T, Tsunoda D, Sasaki T, Tajika T, Yamamoto A, Takagishi K. Prevalence of Chronic Nonspecific Low Back Pain and Its Associated Factors among Middle-Aged and Elderly People: An Analysis Based on Data from a Musculoskeletal Examination in Japan. Asian spine journal. 2017 Dec 1; 11)6 (: 989-97. ##

3.Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine. 1996;21)22(:2640-50##

4.Critchley DJ, Coutts FJ. Abdominal muscle function in chronic low back pain patients: measurement with real-time ultrasound scanning. Physiotherapy. 2002;88)6(:322-32##

5.Rozenberg S. Chronic low back pain: definition and treatment. La Revue du praticien. 2008 Feb; 58)3 (: 265-72. ##

6. Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, et al. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Care & Research. 2008;59)5(:632-41. ##

7.Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, et al. Comparison of stratified primary care management for low back pain with current best practice [STarT Back]: a randomised controlled trial. The Lancet. 2011;378)9802(:1560-71. ##

8.Abedi M, Manshadi FD, Khalkhali M, Mousavi SJ, Baghban AA, Montazeri A, et al. Translation and validation of the Persian version of the STarT Back Screening Tool in patients with nonspecific low back pain. Manual therapy. 2015;20)6(:850-4. ##

9.Bunce SM, Moore AP, Hough AD. M-mode ultrasound: a reliable measure of transversus abdominis thickness? Clinical biomechanics) Bristol, Avon (. 2002;17)4(:315-7. ##

10. Springer BA, Mielcarek BJ, Nesfield TK, Teyhen DS. Relationships among lateral abdominal muscles, gender, body mass index, and hand dominance. Journal of Orthopaedic & Sports Physical Therapy. 2006 May; 36)5 (: 289-97. ##

11.          Hodges P, Pengel L, Herbert R, Gandevia S. Measurement of muscle contraction with ultrasound imaging. Muscle & nerve. 2003;27)6(:682-92##

12. Mannion AF, Pulkovski N, Toma V, Sprott H. Abdominal muscle size and symmetry at rest and during abdominal hollowing exercises in healthy control subjects. Journal of Anatomy. 2008 Aug 1; 213)2(:173-82. ##

13.          Aboufazeli M, Afshar-Mohajer N. Within-day and between-day reliability of thickness measurements of abdominal muscles using ultrasound during abdominal hollowing and bracing maneuvers. J Bodyw Mov Ther. 2018;22)1(:122-8. ##

14. Ogon M, Krismer M, Söllner W, Kantner-Rumplmair W, Lampe A. Chronic low back pain measurement with visual analogue scales in different settings. Pain. 1996;64)3(:425-8. ##

15. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27)1(:117-26. ##

16. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17[1]:45-56##

17. Dansie EJ, Turk DC. Assessment of patients with chronic pain. British journal of anesthesia. 2013 Jul 1; 111)1(:19-25. ##

18. Teyhen DS, Gill NW, Whittaker JL, Henry SM, Hides JA, Hodges P. Rehabilitative ultrasound imaging of the abdominal muscles. Journal of orthopaedic & sports physical therapy. 2007; 37)8(:450-66. ##

19. Manshadi FD, Parnianpour M, Sarrafzadeh J, Azghani M, Kazemnejad A. Abdominal hollowing and lateral abdominal wall muscles' activity in both healthy men & women: An ultrasonic assessment in supine and standing positions. Journal of bodywork and movement therapies. 2011;15(1):108-13. ##

20. Cairns MC, Harrison K, Wright C. Pressure biofeedback: a useful tool in the quantification of abdominal muscular dysfunction? Physiotherapy##

21. de Paula Lima PO, de Oliveira RR, Costa LO, Laurentino GE. Measurement properties of the pressure biofeedback unit in the evaluation of transversus abdominis muscle activity: a systematic review. Physiotherapy. 2011; 97(2):100-6. ##

22. Ferreira LC, Araujo AC, Oliveira CB, Jassi FJ, Oliveira VC, Negrão Filho RD. Association between abdominal muscles recruitment with clinical outcomes and prognostic risk in patients with chronic non-specific low back pain: a preliminary study. Fisioterapia e Pesquisa. 2016; 23(1):45-51##

23. Mannion AF, Caporaso F, Pulkovski N, Sprott H. Spine stabilization exercises in the treatment of chronic low back pain: a good clinical outcome is not associated with improved abdominal muscle function. European Spine Journal. 2012 Jul 1; 21(7):1301-10. ##

24. Wong AY, Parent EC, Funabashi M, Kawchuk GN. Do changes in transversus abdominis and lumbar multifidus during conservative treatment explain changes in clinical outcomes related to nonspecific low back pain? A systematic review. The Journal of Pain. 2014 Apr 1; 15(4):377-e1. ##

25. Fritz JM, Beneciuk JM, George SZ. Relationship between categorization with the STarT Back Screening Tool and prognosis for people receiving physical therapy for low back pain. Physical therapy. 2011;91)5(:722-32. ##

26. Kongsted A, Johannesen E, Leboeuf-Yde C. Feasibility of the STarT back screening tool in chiropractic clinics: a cross-sectional study of patients with low back pain. Chiropractic & manual therapies. 2011;19)10( :1-7. ##

27. Toh I, Chong HC, Suet-Ching Liaw J, Pua YH. Evaluation of the STarT Back Screening Tool for prediction of low back pain intensity in an outpatient physical therapy setting. journal of orthopaedic & sports physical therapy. 2017 Apr;47(4):261-7##

28. Medeiros FC, Costa LO, Oliveira IS, Oshima RK, Costa LC. The use of STarT BACK Screening Tool in emergency departments for patients with acute low back pain: a prospective inception cohort study. European Spine Journal. 2018:1-8. ##

29. Barnett F, Gilleard W. The use of lumbar spinal stabilization techniques during the performance of abdominal strengthening exercise variations. Journal of Sports Medicine and Physical Fitness. 2005;45)1(:38##

30.Teyhen DS, Rieger JL, Westrick RB, Miller AC, Molloy JM, Childs JD. Changes in deep abdominal muscle thickness during common trunk-strengthening exercises using ultrasound imaging. journal of orthopaedic & sports physical therapy. 2008;38)10(:596-605. ##

31.Ainscough-Potts A-M, Morrissey MC, Critchley D. The response of the transverse abdominis and internal oblique muscles to different postures. Manual therapy. 2006;11)1(:54-60##